Bioethics

Ethical Considerations For The Second Phase Of Vaccine Prioritisation

By Jonathan Pugh and Julian Savulescu

 

As the first phase of vaccine distribution continues to proceed, a heated debate has begun about the second phase of vaccine prioritisation, particularly with respect to the question of whether certain occupations, such as teachers and police officers amongst others, should be prioritised in the second phase. Indeed, the health secretary has stated that the government will look “very carefully” at prioritising shop workers – as well as teachers and police officers – for COVID vaccines. In this article, we will discuss moral and scientific reasons for and against different prioritisation strategies.

The first phase of the UK’s Joint Committee on Vaccination and Immunisation (JCVI)’s guidance on vaccine prioritisation outlined 9 priority groups. Together, these groups accommodated all individuals over the age of 50, frontline health and social care workers, care home residents and carers, clinically extremely vulnerable individuals, and individuals with pre-existing health conditions that put them at higher risk of disease and mortality. These individuals represent 99% of preventable mortality from COVID-19. Prioritising these groups for vaccination will mean that the distribution of vaccines in a period of scarcity will save the greatest number of lives possible.

In their initial guidance, the JCVI also suggested that a key focus for the second phase of vaccination could be on further preventing hospitalisation, and that this may require prioritising those in certain occupations. However, they also note that the occupations that should be prioritised for vaccination are considered an issue of policy, rather than an issue that the JCVI should advise on.

We shall suggest that the input of the JCVI is absolutely crucial to making an informed and balanced policy decision on this matter. But what policy should be pursued? Here, we outline some of the ethical considerations that bear on this policy decision.

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Pandemic Ethics: Saving Lives and Replaceability

Written by Roger Crisp

Imagine two worlds quite different from our own. In Non-intervention, if a person becomes ill with some life-threatening condition, though their pain may be alleviated, no attempt is made to save their lives. In Maximal-intervention, everything possible is done to save the lives of those with life-threatening conditions. Continue reading

PRESS RELEASE: Racial Justice Requires Ending Drug War, Say Leading Bioethicists

PRESS RELEASE: Free all non-violent criminals jailed on minor drug offences, say experts

Non-violent offenders serving time for drug use or possession should be freed immediately and their convictions erased, according to research published in the peer-reviewed The American Journal of Bioethics.

More than 60 international experts including world-leading bioethicists, psychologists and drug experts have joined forces to call for an end to the war on drugs which they argue feeds racism.

All drugs currently deemed illicit – even crack cocaine and heroin – should be decriminalized as a matter of urgency, according to this new alliance. Legalisation and regulation should then follow with restrictions on age, advertising and licensing, they say.

They have analysed evidence from over 150 studies and reports, concluding that prohibition unfairly affects Black and Hispanic people, damages communities, and violates the right to life as illustrated by the killing of medical worker Breonna Taylor in March last year.

“The ‘war on drugs’ has explicitly racist roots and continues to disproportionately target certain communities of color,” say lead study authors Brian D. Earp from Yale University and the University of Oxford and Jonathan Lewis from Dublin City University.

“Drug prohibition and criminalization have been costly and ineffective since their inception. It’s time for these failed policies to end.

“The first step is to decriminalize the personal use and possession of small amounts of all drugs currently deemed to be illicit, and to legalize and regulate cannabis. Policymakers should pursue these changes without further delay.”

Their research adds to growing calls for drug policy reform at a time of renewed focus on injustices faced by Black people, and cannabis legalisation for recreational use by a growing list of US states.

The study is based on evidence from existing research into how drug prohibition affects users, communities and human rights, and the impact of decriminalisation by governments.

The authors found that prohibition creates conditions for individuals to commit offences such as burglaries to fund their habit. This lowers life expectancy because people end up in prison, and triggers a ‘multitude’ of health-related costs from unsafe drug use.

Communities are damaged by illicit markets which undermine drug purity, with Black and Hispanic men more likely to end up in the criminal justice system. The war on drugs makes people more vulnerable to violations of their rights including what they choose to put in their bodies.

In contrast, the study highlights the liberal approach of countries such as Portugal where drug-related deaths have fallen and where users are encouraged to seek treatment.

An estimated £43.5bn ($58bn) could be generated in federal, state and local tax revenues through the legalization of drugs, according to the findings. This compares with an annual federal, state and local spend of more than £35bn ($47bn) on prohibition.

The authors stress that non-violent prisoners found with a small amount of illegal substances should be released.

Further Information

The study’s senior author Carl L. Hart was Columbia University’s first tenured African American professor of sciences. He is open about the fact he uses recreational drugs and his book Drug Use for Grown Ups is set for publication in January 2021.

For an interview, please contact:

Brian D. Earp (brian.earp@yale.edu), Jonathan Lewis (Jonathan.Lewis@dcu.ie), or Carl L. Hart (c.hart@columbia.edu)

For a copy of the paper, visit: https://newsroom.taylorandfrancisgroup.com/embargoed-releases/ 

For a copy of the journal article, please contact:
Simon Wesson, Press & Media Relations Executive
Email: newsroom@taylorandfrancis.com
Tel.: +44 (0)20 701 74468
Follow us on Twitter: @tandfnewsroom

The article will be freely available once the embargo has lifted via the following link: https://www.tandfonline.com/doi/full/10.1080/15265161.2020.1861364

This Machine Kills Viruses

Written by Stephen Rainey

If we had a machine that could eradicate coronavirus at the press of a button, there would likely be a queue to do the honours. Rather than having such a device, we have a science-policy interface, and a general context of democratic legitimacy. This isn’t a push-button, but a complex of socio-political liberties and privations. We can’t push the button, but we can learn how to use the technology we do have – by collectively following policies like staying inside, wearing masks outside, and keeping distance from others.

Because of the coronavirus pandemic a novel form of this scientific research, technological application, and influence or control of nature (including humans) is emerging. In this case, the application is public policy, as based on multitudes of scientific advice. That over which control is sought is twofold: the virus, and people. Control of the virus is not really possible without some control over the people. Likewise, control of the people becomes harder where the virus is not controlled. Public trust in tough policies wanes if there is no end in sight, or no clear rationale in place. Continue reading

Even Though Mass Testing For COVID Isn’t Always Accurate, It Could Still Be Useful – Here’s Why

By Jonathan Pugh

This article was originally published here by the Conversation, on 22nd Dec 2020

 

The mass testing of asymptomatic people for COVID-19 in the UK was thrown into question by a recent study. In a pilot in Liverpool, over half the cases weren’t picked up, leading some to question whether using tests that perform poorly is the best use of resources.

The tests involved in this study were antigen tests. These see whether someone is infected with SARS-CoV-2 by identifying structures on the outside of the virus, known as antigens, using antibodies. If the coronavirus is present in a sample, the antibodies in the test bind with the virus’s antigens and highlight an infection.

Antigen tests are cheap and provide results quickly. However, they are not always accurate. But what do we mean when we say that a test is inaccurate? And is it really the case that “an unreliable test is worse than no test”? Continue reading

Refusal Redux. Revisiting Debate About Adolescent Refusal of Treatment.

by Prof Dominic Wilkinson @Neonatalethics

Last month, in an emergency hearing, the High court in London heard a case that characterises a familiar problem in medical ethics. A 15 year old adolescent (known as ‘X’) with a long-standing medical condition, Sickle Cell disease, had a very low blood count and required an urgent blood transfusion. However, X is a Jehovah’s Witness and did not wish to receive blood as it was contrary to her religious beliefs. X’s doctors believed that she was at risk of very serious health consequences without a blood transfusion (a stroke, or even death).

Of no great surprise to anyone, the court authorised the emergency blood transfusion for X. Although X was “mature and wise beyond her years”, and judged to be ‘Gillick competent’ (see below), the judge made the decision in her best interests.

That decision is consistent with many previous cases that have come to the courts in the UK and overseas (see here, here, here )[1]. It is very similar to the case in Ian McEwan’s novel and film “The Children Act” (the book, had been based on real cases before the courts). The courts, in the UK at least, have always decided to over-rule under-eighteens who wish to refuse potentially life-saving treatment. Once the teenager reaches the age of eighteen, the decision is different, however. At that point, if they are judged to have “capacity”, (ie they have the ability to use, understand, and communicate the information necessary for a decision)  they can refuse even if the treatment would certainly save their life.

Although the decision is unsurprising, the judge made a comment implying that future cases might not always reach the same conclusion. X’s lawyer argued that the traditional legal approach may be “in need of urgent re-analysis and review”, and the judge appeared to agree that these arguments needed careful consideration (not possible acutely given the urgency of X’s case).

Should the ethical and legal approach to adolescents who refuse treatment change?

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Antenatal Care During The COVID-19 Pandemic: Couples As Dyads

Written by Rebecca Brown

 

During the pandemic, many healthcare services have been reduced. One instance of this is the antenatal care of expectant mothers. Ordinarily, partners of pregnant women are permitted to attend appointments. This includes the 12 week scan: typically the first opportunity expectant parents get to see the developing foetus, to discover whether it has a heartbeat and is growing in the right place. This can be very exciting and, if there’s bad news, devastating. It also includes scans in mid pregnancy and (for first-time mothers) at 36 weeks, as well as the entirety of labour.

During the pandemic, many healthcare providers have restricted attendance at antenatal appointments as well as labour and postnatal care. Even when lockdown restrictions were eased, with pubs, zoos and swimming pools re-opening and diners in England being encouraged to Eat Out to Help Out, some hospitals continued to exclude partners from all antenatal appointments and all but the final stage of labour, requiring them to leave shortly after birth. This included cases where mother and newborn had to remain on wards for days following delivery. With covid cases rising, it seems likely that partners will once again be absent from much antenatal, labour, and postnatal care across the country. Continue reading

The Duty To Ignore Covid-19

By Charles Foster

This is a plea for a self-denying ordinance on the part of philosophers. Ignore Covid-19. It was important that you said what you have said about it, but the job is done. There is nothing more to say. And there are great dangers in continuing to comment. It gives the impression that there is only one issue in the world. But there are many others, and they need your attention. Just as cancer patients were left untreated because Covid closed hospitals, so important philosophical problems are left unaddressed, or viewed only through the distorting lens of Covid. Continue reading

We’re All Vitalists Now

By Charles Foster

It has been a terrible few months for moral philosophers – and for utilitarians in particular. Their relevance to public discourse has never been greater, but never have their analyses been so humiliatingly sidelined by policy makers across the world. The world’s governments are all, it seems, ruled by a rather crude vitalism. Livelihoods and freedoms give way easily to a statistically small risk of individual death.

That might or might not be the morally right result. I’m not considering here the appropriateness of any government measures, and simply note that whatever one says about the UK Government’s response, it has been supremely successful in generating fear. Presumably that was its intention. The fear in the eyes above the masks is mainly an atavistic terror of personal extinction – a fear unmitigated by rational risk assessment. There is also a genuine fear for others (and the crisis has shown humans at their most splendidly altruistic and communitarian as well). But we really don’t have much ballast.

The fear is likely to endure long after the virus itself has receded. Even if we eventually pluck up the courage to hug our friends or go to the theatre, the fear has shown us what we’re really like, and the unflattering picture will be hard to forget.

I wonder what this new view of ourselves will mean for some of the big debates in ethics and law? The obvious examples are euthanasia and assisted suicide. Continue reading

Forced Medical Feeding

By Roger Crisp

At a recent New St Cross Special Ethics Seminar Prof. Noam Zohar of the Dept. of Philosophy, Bar Ilan University and a member of Israel’s National Bioethics Council, spoke on ‘Debating Forced Medical Feeding: A Critical Examination of Israeli Responses to Hunger Strikes’. Continue reading

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